Melissa L Gilliam1, Summer L Martins2, Emily Bartlett2, Stephanie Q Mistretta2, Jane L Holl3. 1. Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL. Electronic address: mgilliam@babies.bsd.uchicago.edu. 2. Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL. 3. Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Abstract
OBJECTIVE:Long-acting reversible contraceptive (LARC) methods, such as the intrauterine device and implant, are highly effective but used by less than 10% of US women. The objective of our study was to improve LARC interest by enhancing clinic counseling. STUDY DESIGN: A quality improvement methodology was used to evaluate intrauterine device service delivery in 3 Chicago Title X clinics. To address identified barriers, we developed a theory-based iOS application (app) for patients to use in the clinic waiting room using human-centered design. The final prototype was tested in a randomized controlled trial in a Title X clinic with sexually active females (79% African American) under age 30 years. Our sample of 60 was chosen to detect an increase from 10% (baseline) to 45% (app intervention) in the proportion of patients expressing interest in discussing a LARC method during their clinic visit with 80% power and two-sided α = 0.05. After completing demographic and baseline knowledge questionnaires, participants were randomized 1:1 to intervention (app) or standard care arms. App users also completed a posttest. Our primary outcome was expressed interest in discussing a LARC method during the clinic visit. Secondary outcomes were contraceptive knowledge and LARC selection. RESULTS: App testers (n = 17) preferred interactive, visually appealing design and video testimonials. In the pilot randomized controlled trial (n = 52), app users had a significantly higher knowledge of contraceptive effectiveness (P = .0001) and increased interest in the implant (7.1-32.1%, P = .02) after the intervention. Users were highly satisfied with the app. Staff reported no problems using the app in the clinic. CONCLUSION: Use of a theory-based counseling app offers a novel method to optimize wait time while minimizing clinic flow disruption. Preliminary data demonstrate that app use was associated with improvements in patients' contraceptive knowledge and interest in the implant.
RCT Entities:
OBJECTIVE: Long-acting reversible contraceptive (LARC) methods, such as the intrauterine device and implant, are highly effective but used by less than 10% of US women. The objective of our study was to improve LARC interest by enhancing clinic counseling. STUDY DESIGN: A quality improvement methodology was used to evaluate intrauterine device service delivery in 3 Chicago Title X clinics. To address identified barriers, we developed a theory-based iOS application (app) for patients to use in the clinic waiting room using human-centered design. The final prototype was tested in a randomized controlled trial in a Title X clinic with sexually active females (79% African American) under age 30 years. Our sample of 60 was chosen to detect an increase from 10% (baseline) to 45% (app intervention) in the proportion of patients expressing interest in discussing a LARC method during their clinic visit with 80% power and two-sided α = 0.05. After completing demographic and baseline knowledge questionnaires, participants were randomized 1:1 to intervention (app) or standard care arms. App users also completed a posttest. Our primary outcome was expressed interest in discussing a LARC method during the clinic visit. Secondary outcomes were contraceptive knowledge and LARC selection. RESULTS: App testers (n = 17) preferred interactive, visually appealing design and video testimonials. In the pilot randomized controlled trial (n = 52), app users had a significantly higher knowledge of contraceptive effectiveness (P = .0001) and increased interest in the implant (7.1-32.1%, P = .02) after the intervention. Users were highly satisfied with the app. Staff reported no problems using the app in the clinic. CONCLUSION: Use of a theory-based counseling app offers a novel method to optimize wait time while minimizing clinic flow disruption. Preliminary data demonstrate that app use was associated with improvements in patients' contraceptive knowledge and interest in the implant.
Authors: Adam K Lewkowitz; Nandini Raghuraman; Julia D López; George A Macones; Alison G Cahill Journal: Am J Perinatol Date: 2018-12-19 Impact factor: 1.862
Authors: Rachel H DeMeester; Fanny Y Lopez; Jennifer E Moore; Scott C Cook; Marshall H Chin Journal: J Gen Intern Med Date: 2016-06 Impact factor: 5.128
Authors: Karen Pazol; Lauren B Zapata; Stephen J Tregear; Nancy Mautone-Smith; Loretta E Gavin Journal: Am J Prev Med Date: 2015-08 Impact factor: 5.043
Authors: Meredith Fischer; Nadia Safaeinili; Marie C Haverfield; Cati G Brown-Johnson; Dani Zionts; Donna M Zulman Journal: J Gen Intern Med Date: 2021-02-03 Impact factor: 5.128